Bar Code Medication Administration and MAR Resource Manual
Downtime
Downtime Procedure for Medication & IV Administration ...........................................................2
Back Charting Meds After a Downtime .......................................................................................4
Charting Meds on the MAR During CareMobile Downtime .........................................................6
Downtime Medication Administration Record .............................................................................8
Downtime Flowchart ...................................................................................................................9
Troubleshooting Downtime .......................................................................................................11
1
Downtime Procedure for Medication & IV Administration
Scheduled Downtime
The paper MAR (pMAR) will be sent to printers on all nursing units 1 hour prior to an
anticipated downtime of 2 hours or greater.
1. Review the pMAR and compare it to the eMAR, making changes to the pMAR as
needed.
2. Orders that have not been verified will not appear on the pMAR; they will be on the
eMAR with a mortar and pestle icon. Write these on the pMAR.
3. Check the paper chart for any orders that Pharmacy may not have entered into
PowerChart yet; write these on the pMAR.
4. Verify that the last dose information is correct.
Unscheduled Downtime
1. After downtime is announced, pMARs will be sent to unit printers. The MAR is
downloaded every hour, ready in the event of a downtime. Depending on when the
downtime begins, the information on the pMAR could be as up to date as one minute
ago or as old as one hour.
2. Read-Only PowerChart, available on all computers, will contain the eMAR.
However, it takes 1 hour for the information to download, so data will always be at
least one hour old.
3. Go to the orders section of the gray chart to review the most current medication
orders and validate the data against the pMAR.
4. Before the printed MAR is available, the nurse will use a blank MAR to document
any medications given. The information on this form should be transcribed onto the
downtime pMAR or back loaded in the computer.
Sample Downtime MAR
Report As Of 12/30/05 10:00
x
1 tab at 0900
Last charted entry 1 tab at 12/30/05
09:00 by shintz
Last dose given is noted on downtime MAR.
2
CareMobile Downtime
If CareMobile is down and PowerChart is up:
1. Paper MAR s will be sent to the unit printers to use as a guide
2. Chart on the MAR. See ‘Charting Meds on the MAR during CareMobile Downtime.’
Network Downtime
When the network goes down the MARs will not print to the unit computers.
MMC: Computer operations will print paper MARs from a local computer that
downloads MAR information on an hourly basis. The MARs will be hand-delivered to
each unit.
KMHC: Computer operations will print paper MARs from a local computer that
downloads MAR data on an hourly basis. The paper MARs will be faxed to the site.
POMH: Computer operations will print paper MARs from a local computer that
downloads MAR data on an hourly basis. The paper MARs will be faxed to the site.
Mercy Cadillac Hospital: A local computer in pharmacy downloads MAR information
on an hourly basis. Pharmacy will print the paper MARs and the nursing supervisor will
distribute them.
After hours: The nursing supervisor will notify the on-call pharmacist. The
pharmacist will come in to the hospital and print the paper MARs. The nursing
supervisor will distribute the MARs.
Mercy Grayling Hospital: A local computer in pharmacy downloads MAR information
on an hourly basis. Pharmacy will print and distribute the paper MARs.
After hours: The supervisor will notify the on-call pharmacist. The pharmacist
will give the supervisor the pharmacy code and the nursing supervisor will print
and distribute the paper MARs.
Extended Downtime
When Downtime extends beyond the date and time of the last column of the downtime
MAR (see previous page), continue to use the same MAR, recording med
administrations with date and time in Red ink.
When downtime is extended beyond the last 0700 column again, rewrite the MAR
using a blank MAR.
Following Downtime
All medications given during downtime will be entered into PowerChart regardless of the
length of downtime. After charting, place the pMAR in the “to be shredded” recycle bin.
Exception: If the clinician who administered the med has gone off shift, the clinician
caring for the patient will electronically document the meds given. The pMAR will be
retained in the paper chart as the record of who gave the meds. Record on the pMAR
that meds have been entered electronically.
3
Back Charting Meds After a Downtime
Back Charting Scheduled Meds
1.
2.
3.
4.
5.
6.
Open PAL
Double click on Overdue column header to list overdue tasks for all your patients
Compare PAL to pMAR to make sure med administration time matches due time
De-select any tasks you do not want to chart (uncheck the gray box in front of the
task.) De-select those where administration time doesn’t match scheduled time
Click Quick Chart; this assigns the scheduled time as the med administration time
Click Chart for those meds where the administration time does not match
scheduled time. Charting window will open, allowing you to change the
administration time.
Double-click on header bar to
see all patients’ tasks
1. Review meds
2. Un-check meds you
do not want to chart
3. Click Quick Chart
4
Back Charting IVs and PRN Meds
1. Double-click the PRN/Continuous column heading
2. Click the check box in front of the meds/IVs you want to chart
3. Click Chart button
4. Charting windows will open; check & change the performed time
Note: Do not use the Quick Chart button in the PRN/Continuous column.
Quick Chart assigns the current time as the given time; it does not give you the chance to
change the time.
Chart gives you the opportunity to change the administration time.
Select the tasks
by clicking in
the box
Change Performed time/date
On the IV charting window,
click Apply to activate the
Sign button
Vaccine Documentation
The lot number field does not allow alpha characters on the PAL or MAR.
After charting the vaccine administration and manufacturer’s name using Quick Chart
on the PAL:
1. Go to the MAR in PowerChart
2. Right-click on the charted task in the Discontinued Scheduled section
3. Click Add Comment
4. Enter lot # in the Comment field
5
Charting Meds on the MAR During CareMobile Downtime
1. Click the medication in the Administration column
Click medication
The medication charting window displays.
Sign
button
2. Review the data in the fields
3. Make corrections and/or additions as needed
4. Click the Sign button
Charting PRNs and IV Begin Bags
1. Click the medication or IV in the current time column
6
2. Change the time. (PRN and IVs display current time)
Change time
Enter dose
3. Fill in all fields that are appropriate
4. Click Sign (meds)
5. Click Apply and Sign (IVs)
Example of IV Charting window
Change time/date
Click Apply before
clicking Sign
Site is a required field
7
Downtime Medication Administration Record
Scheduled meds display all doses that have been charted up to the time it is
printed. It will also display the last charted in the medication column.
Unscheduled (PRN) meds display the last charted dose of the medication in
the medication column only.
8
Downtime Flowchart
Downtime
Downtime Process for eMAR Flowchart
(pg 1 of 2)
Is Downtime
scheduled?
NO
Network down?
YES
Is it on an
eMAR unit?
NO
WebSphere
down?
NO
PowerChart
down
YES
eMAR unit?
YES
Continue to use
normal pMar
NO
printed from Ops
jobs
YES
Is nursing unit
an eMAR
unit?
YES
PowerChart
down?
NO
Downtime
coordinator
schedule Ops job
YES
NO
Continue with
normal pMAR
Operations prints
downtime eMAR
to nursing units
printers
A
A
Operations prints
downtime pMAR
YES
Prints scheduled
ops jobs
Downtime eMAR
to nursing units
Operations will
distribute to
nursing units
A
Is Downtime
extended past
7 am?
NO
System
up
YES
Use the same downtime
MAR that you have been
currently charting on. Using
RED ink
Write new orders on
downtime
MAR
A
YES
A
eMAR unit?
NO
IS unlock eMAR/
PAL
Nursing charts on
eMAR/PAL
NO
B
(pg 2)
Websphere
available?
NO
YES
IS lock eMAR/PAL
Is downtime
extended past 7 am
again?
YES
Re write MAR
Nursing uses Care
Mobile for
medication admin
charting
Updated 1-27-07
9
Downtime Process for eMAR
Flowchart (pg 2 of 2)
Up time Steps
B
Pharmacy to back
load orders
NO
RX caught up
with orders?
YES
eMAR unit?
NO
Continue
documenting on
pMAR
YES
Begin medication
order charting
using Care Mobile
Med/IV's given
during downtime?
NO
Continue current
Med process
YES
Downtime
greater than one
hour?
NO
Backchart all
Meds IV's bags
started from Care
Mobile
YES
IS unlock eMAR /
PAL (will
remained
unlocked for 4hrs)
Patient
discharged?
YES
Store pMAR in
chart
NO
Back chart all
meds given and
IV's started
From PAL Quick
Chart
Charting for
someone else?
NO
Destroy paper
IS to lock eMAR/PAL
YES
Indicate on pMAR
meds entered
electronicallly
updated 7-17-06
10
Troubleshooting Downtime
Patient is discharged during a downtime
How do I chart the meds?
After the downtime the med tasks are no longer in PowerChart. Keep the downtime paper
MAR as the legal record of medication administration.
Downtime MAR has yesterday’s date
Where do I chart today’s meds?
Downtime MAR printed between midnight and 0700 will have columns for the 0700 of the
previous day to 0700 of the current day.
When Downtime extends beyond the date and time of the last column of the downtime MAR,
continue to use the same MAR, recording in Red ink med administrations with date and time.
When downtime is extended beyond the last 0700 column again, rewrite the MAR using a
blank MAR.
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